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Final Waiver of Lien <br />State oflndiana, County of J SS: <br />an (Name of Off b y <br />Bain duly sworn that he/she is the O <br />Officer) (Title) <br />of _ I&- having contracted with ` J t ::5-, �K „ <br />(Contractor) (Owner) <br />to furnish certain materials andlor labor as follows:tmm�. <br />(Description) <br />for a project known as ( "t '"., off <br />Name ofP U t A D I z <br />(N rojeot) <br />located at <br />and owned by <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars W. <br />❑ receipt of which is hereby aclatowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further cartifled that no other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for said project, and wlthin the scope of this Affidavit <br />and Waiver of Lim <br />By <br />(Firm) A4t ad Represc �11) <br />STATE OF INDIANA ) <br />SS: <br />ST, JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />ed my e and affi <br />xed my official seal on the 3 day of <br />�WITNESS WHEREOF, I have hereunto subscribed � 1 <br />N Public Signature <br />M Commission Expires: <br />' <br />Y yy p� �. II <br />J e- <br />Residing in i i ,r V d County, h Notary Public Name <br />Julie Romero <br />.,. St. Joseph County <br />MY Commission Expires <br />February w 1 <br />